The Simplification Of Prior Authorisation With Orbit

Wednesday, 27 November 2024, 10:36 am
Article: Hugh Grant

Prior authorisation in the healthcare field is essentially a request from a provider to an insurance payer to obtain authorization for healthcare services. While this system may seem beneficial to the healthcare world, 1 in 3 providers say prior authorisation processing delays have led to delays in seeing patients. The question then falls on the authorisation system and how its technology can operate smoother to ease inefficiencies and get patients the care they need.

The manual method of prior authorisation includes checking patient insurance details/medical charts, manually submitting PA requests, and following up with the provider. If authorisation is denied along the way, additional information must be provided through documentation or the staff must prepare an appeal letter of resubmission. These steps may involve calling the patient's insurance company, waiting in a call queue, checking online portals, and 15-20 minute waiting times on PA requests.

The automated method of prior authorisation includes retrieving required patient data and medical information, reading documents and validating information, and preparing PA requests. The program also automatically updates medical records, and identifies the status of the patient, retrieving more information if necessary.

Because prior authorisation process automation is incredibly complex and rigid, serious side effects have occurred within the healthcare space. Physicians have been impacted through an increase in expenses on medical staff, with 35% of providers having hired staff members to work exclusively on prior authorization. Higher costs at $11 per manual authorization, wasting 20 minutes on the task in the process. Additionally, 93% of physicians saying prior authorizations leave them with “high” or “extremely high” administrative burdens. Patients also face difficulties with the transitional systems. In a survey of 1,000+ providers, prior authorisation can lead to 100% delays in access to care, 25% chance of hospitalisation, a 19% chance of life-threatening events, or even a 9% chance of disability or permanent damage.

Both patients and providers are reasonably worried about these new trends with 27% of physicians saying their patients’ authorisations are often denied, and 35% of physicians reporting that prior authorization criteria are rarely or never evidence-based. Nearly three in four doctors say that denials have increased somewhat significantly over the past five years. While these factors are at play, one in five physicians always appeal negative prior authorization decisions even with most not having the time or resources to spend on this matter. Nearly 70% of patients and physicians rely on manual authorization, so Orbit has come into play as a solution.

Orbit’s Ai-powered prior authorisation automation system saved providers about 60% of their existing costs, and $449 million in cost savings in the US medical industry. Replacing the manual authorisation process with Orbits technology can offer a number of benefits aside from cost savings.

These benefits include an improved patient experience by reducing the time it takes to render care to a patient. It streamlines workflows by saving up to 24 hours of wasted time per day per provider group that operates with 5 or more prior authorization team members. It is far more efficient, as it takes only 5 minutes to process a patient's information and schedule appointments. It is more accurate, with its technology capturing demographics and insurance/medical information without the interference of humans who may make small errors in the process. The automated PA systems save up to $9.60 per authorisation for both providers and payers. Reduced turnaround costs are also a positive, saving up to 11 minutes per authorisation, a reduction of 55%. Finally there is a reduced dependency on labor where each staff member can save nearly 12 hours a week on what would have been manual authorization.

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